Phone-game risk-taking shifts preceded heavier drinking in 603 people with alcohol use disorder
In a one-year observational study, month-to-month changes in decision making preceded changes in drinking, but not the reverse. The effects were small, the authors reported.
A team led by Hilmar Zech (University Hospital Würzburg and TU Dresden) and Lorenz Deserno followed 603 people with mostly mild-to-moderate alcohol use disorder for one year. The results were published in Biological Psychiatry Cognitive Neuroscience and Neuroimaging. Participants completed gamified tasks on their smartphones once a month and reported their alcohol consumption every two days. Monthly changes in some aspects of decision making preceded later changes in drinking. doi.org
Biological Psychiatry Cognitive Neuroscience and Neuroimagingdoi.orgOpen source ↗
Design: monthly tasks, tracking within each person
The tasks measured two domains: cognitive control (working memory and response inhibition) and decision making (risk-taking and information sampling). According to Earth.com, participants were aged 16 to 65 and played four five-minute games every four weeks. They reported what they drank from a list of 19 options. One standard drink was taken as 12 grams of pure alcohol. Participants averaged about three such drinks a day, and about five on days when they drank.
The analysis followed changes within each person rather than comparing heavier and lighter drinkers. Earlier cross-sectional studies had linked alcohol use disorder to reduced cognitive control and riskier decisions, but could not show which came first. doi.org
Biological Psychiatry Cognitive Neuroscience and Neuroimagingdoi.orgOpen source ↗
Results: decisions came first, drinking followed
Participants shifted to higher monthly consumption when, in the preceding month, their risk-taking was higher in a mixed gambling context and lower in a loss context. Drinking also rose in the month after information sampling biases decreased. The reverse direction was not observed, and the forward link survived correction for autocorrelation in drinking. doi.org
Biological Psychiatry Cognitive Neuroscience and Neuroimagingdoi.orgOpen source ↗
Fluctuations in cognitive control and in risk-taking in a win context were not associated with changes in drinking. Per Earth.com, higher working memory was linked to lower average drinking across the year, but only between people, not within one person over time.
Limits of the findings
The effects were small, and the authors wrote that they are likely too small to be useful in a clinic yet. The sample was planned to be split in two halves, the second meant to confirm the first. The pattern was clear in the first half and not in the second, though the halves did not differ when compared directly. Of the 603 participants, 218 dropped out early; their data were kept in the analysis.
The study is observational and cannot establish that risky choices caused the drinking. The authors suggest that smartphone tasks could help identify periods of heightened risk and support real-time interventions. This approach has not been tested. doi.org
Biological Psychiatry Cognitive Neuroscience and Neuroimagingdoi.orgOpen source ↗
